CMS Bundled Payment Initiative to Begin Testing in April

More than 500 organizations will
begin participating in the Centers for Medicare and Medicaid Services' (CMS) bundled payments for care improvement initiative, made possible by the Affordable Care Act. Through this
initiative CMS will test how bundling payments for episodes of care can result
in more coordinated care for beneficiaries and lower costs for Medicare.

The bundled payment initiative
includes 4 models of bundling payments, varying by the types of health care
providers involved and the services included in the bundle. Depending on
the model type, CMS will bundle payments for services that beneficiaries receive
during an episode of care, encouraging hospitals, physicians, postacute
facilities, and other providers as applicable to work together to improve
health outcomes and lower costs. Organizations of providers participating in
the initiative will agree to provide CMS a discount from expected payments for
the episode of care, and then the provider partners will work together to
reduce readmissions, duplicative care, and complications to lower costs through
improvement.

Last week's announcement includes
the selection of 32 awardees in model 1, who will begin testing bundled
payments for acute care hospital stays as early as April. In the coming weeks,
CMS also will announce a second opportunity for providers to participate in model
1, with an anticipated start date of early 2014.

CMS' announcement also marks the
start of phase 1 of models 2, 3, and 4. In phase 1 (January-July 2013), more
than 100 participants partnering with over 400 provider organizations will
receive new data from CMS on care patterns and engage in shared learning in how
to improve care. Phase 1 participants are generally expected to become
participants in phase 2, in which approved participants opt to take on
financial risk for episodes of care starting in July 2013, pending contract
finalization and completion of CMS' standard program integrity reviews.

A
list of the model 1 awardees and participants for phase 1 of models 2, 3, and 4
is available on the Center for Medicare and Medicaid Innovation's website.

Hear
how physical therapists are getting involved in bundled payment initiatives by
attending APTA's
Innovation Summit: Collaborative Care Models. This groundbreaking virtual event will bring
together physical therapists, physicians, large health systems, and policy
makers to discuss the current and future role of physical therapy in integrated
models of care. A panel of experts, moderated by a physical therapist who is
highly involved in bundling initiatives, will provide you with perspectives on
bundling from large health systems, a physical therapy private practice, and
private payers.

Comments

What is the incentive for the first provider to "pass on" the savings from the efficeint care they provide? Dollar amounts per Dx only promotes limited care for the patient. How many providers will treat beyond the "bundled/discounted" rate CMS will pay? How much longer can we accept pay cuts every year?